TREATMENT — When a history of constipation is obtained, even if it is of short duration (ie, less than two weeks), it is important to intervene to prevent the cycle of stool withholding leading to worsening or recurrent or chronic constipation. The intervention should include a follow-up plan to ensure that the constipation has resolved and the child achieves an appropriate stooling pattern (ie, regular bowel movements and fecal continence if appropriate for the child's age).
Toddlers and children
Acute constipation — For children one year and older with hard stools and straining but minimal pain and no withholding behavior, bleeding, or anal fissure, dietary changes may be sufficient. Foods naturally high in fiber (ie, ≥3 grams of fiber per serving)
High fiber foods
Fiber (grams)
Cereal (½ cup serving)
Fiber One 13
100% Bran 12
All Bran 12
Bran Buds 12
Kashi Go Lean 5
Kellogg's Complete Bran Flakes 5
Grape Nuts 5
Raisin Bran* 3 to 5
Cracklin' Oat Bran* 4
100% Whole Grain Wheat Chex 3
Fruit and Fibre 3
Great Grains 3
Frosted Mini Wheats 3
Kellogg's Low Fat Granola 3
Cheerios 2¶
Wheaties 2¶
Instant oatmeal 2¶Δ
Fruit
Pear (one) 4
Strawberries (1 cup) 3
Apple (one, with skin) 3
Dried fruits (eg, raisins) (3 Tablespoons) 3
Papaya (one) 3
Peach (fresh) 2¶
Plums (two) 2¶
Mango 2¶
Nectarine 2¶
Avocado (½ medium) 2¶
Tomato (one medium) 2¶
Vegetables (cooked unless indicated)
Pinto, kidney, black, lima beans (½ cup) 4 to 7
Sweet potato (1 medium) 4
Lentils (½ cup) 4
Jicama (½ raw) 3 to 4
Baked potato with skin (medium) 3
Corn (½ cup) 3
Peas (½ cup) 3
Broccoli (½ cup) 2¶
Cabbage (½ cup) 2¶
Spinach (½ cup) 2¶
Cauliflower (¾ cup) 2¶
Carrots (1 medium raw, or ½ cup cooked) 2¶
should be recommended, along with adequate fluid intake (32 to 64 ounces [960 to 1920 mL] per day) [2]. Information regarding a high fiber diet, and a sample-menu for a 7- to 10-year-old child that can be printed out and given to parents is provided in the tables .
For toddlers and children with stool withholding behavior, pain while defecating, rectal bleeding or anal fissure, we suggest initial treatment with polyethylene glycol (PEG) with or without electrolytes (polyethylene glycol 3350, eg, Miralax) [2]. The recommended dose of PEG is 0.4 g/kg/day (table 3). If the child has a fecal impaction, a higher dose of PEG (1 to 1.5 g/kg/day) for a maximum of six consecutive days can be used. Alternatively, if PEG is not available, lactulose should be the laxative of choice, and is safe for all ages. Anal fissures can be treated topically with petroleum jelly. Meanwhile, the dietary measures described above should be implemented to help avoid recurrent constipation.